Tearing

Anyone have tips on how NOT to tear during birth? I'm currently researching this for a wonderful lady who has had the worst time with tearing during her first two births, and is extremely worried about her third birth coming up! She asked if she should just schedule an early c-section to avoid the 3rd degree tears (1st birth- all the way back, 2nd birth- all the way forward) she experienced with the others. I am unsure as to what to say, as she is clearly physically and emotionally traumatized by those deliveries, and is not in a good mindset for a peaceful labor and birth. She and her husband also want to have the birth at the hospital, which in her state does not allow for any type of midwife or water birth option. She also asked what the problem was with c-sections, and does it affect the baby long term? I've had all my babies at home or in a birth center with midwifes, so I've never come across these kinds of questions before. Any thoughts or links to studies would be appreciated! Thanks....

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One of the articles I read suggested that having a C-section increases the odds of a dead baby by 80%, and unfortunately, this is not something slice happy docs usually tell their clients. Respiratory problems are common with babies born via C-section, and babies born via C-section also don't get the benefit of the cultures produced inside the mama's vagina to prepare it for the outside world http://blogs.discovermagazine.com/80beats/2010/06/22/study-c-sectio.... We also know that C-sections dramatically increase the risk of maternal death - you might want to let her know that the USA has a maternal death crisis that even has Amnesty international weighing in, and many of these deaths are linked to C-sections. Mother's bodies *do not* recover as well from a C-section as they do from natural labor and delivery. For every mama who boasts that she recovered from her C-section 'just fine,' their are numerous others who can't speak because they're dead. For this reason, C-sections should really, TRULY, only be done for a medical emergency, where the benefits outweigh the grave risks.

The scholarly research shows that messaging the perineum 6 weeks before delivery (so everyday starting around weeks 34 to 35 till delivery) dramatically lowers the risk of tearing. There's a specific way this is to be done.

1) It should be done for at least 5 minutes daily 6 weeks prior to delivery.

2) It can be done by either the woman or her partner.

3) Wheat germ oil, available at health-food stores is recommended by some people, but other vegetable oils can be used.

4) She should make herself comfortable, lying in a semi-seated position against some pillows.

5)The first few times she does this, she should take a mirror and look at her perineum (the area between the vagina and rectum) so she knows what she is doing.

6)She should dip her fingers into the oil and rub it into the perineum and lower vaginal wall.

7)If she does the massage herself, it's easiest to use her thumbs. If a partner is doing it, he/she can use their index finger

8)She should put her fingers upward along the sides of the vagina, moving them in a rhythmic U or sling typed movement. This movement will stretch the vaginal tissue (mucosa), the muscles surrounding the vagina, and the skin of the perineum. IN the beginning, she will feel tight, but with time and practice, the tissue will relax and stretch.

9) She should concentrate on relaxing her muscles as she applies pressure. As she becomes comfortable massaging, she should use enough pressure until the perineum just begins to sting form the tension she applies. She will later recognize this stinging as the baby's head is being born and her perineum stretches around it. (if she's going drug free....drug free would probably give her more control of slowly birthing the head, but even if she's planning on using an epidural, these exercises for the perineum will help that area to stretch gently and hopefully avoid tearing.)

Is she going to the same doc she did with her other two births? Because if so, there's a possibility that that particular provider is overly anxious/rushed and is the one causing the tears. There *are* thinks medical providers can do to decrease the risk of tears. In the midwifery community, it's common for them to let the baby take its time and allow the head to be born super slowly to avoid tears. This might involve letting the baby's head come forward and move a bit back ...in some women, this process takes up to an hour. If she has a different doc, and this doc is nature friendly, she might find him or her willing to take the extra time. But if the doc is a clock watcher, she's going to have a problem.

Also - this is important ! - the research shows that when women birth their babies on their sides rather than their backs, their is a dramatic reduction in the occurrence and degree of tears. So if she can discuss with her doctor right now the fact that she wants to birth the baby on her side rather than on her back, this would help her so much. It's her body, and she needs to really insist on this one, as some traditional hospitals will try to convince her that the best way is on the back....but SHE is the one who'll have the tearing when all is said and done, so it's worth it for her to be insistent on this one.

Laboring down is an effective way to avoid tearing. As is non directed pushing. Meaning she only pushes when and how hard she feels she should, even if it means not pushing with every contraction. Hot compresses and mineral oil as well as provider support of the perineum during delivery are also good at helping prevent tears (but neither of these things is usually done by a dr, most prefer to just cut--its easier on them). As others have said perineum massage throughout labor (as well as sex throughout pregnancy) are also shown to be helpful. Her fear and birth positions are also going to impact her likelihood at tearing. If she is scared and tense and fighting the stretching she is more likely to tear and the more tense she is the worse the tear will be. Have her practice meditation, relaxation, and visualization to help her overcome her fears. Much luck to her.

There have been great tips already - massaging the perinium and bearing down only with the natural urge to do so are certainly helpful. The actual birthing position also makes a difference. Lying flat on your back is one of the least favorable birthing positions - squatting leaves less chance of tears.

1.warm compress on the perinium
2.perinial massage
3.let the baby ease out, breath the baby down instead of "pushing" there is no rush! Have her "tell" not "ask" the Dr. that she will be easing the baby out with breathing and slow/gentle nudging and breathing instead of pushing. This gives the skin more time to stretch.